IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 7 Ver. III (July. 2015), PP 27-30
www.iosrjournals.org

Effect of Road Conditions and Number of Passengers on Severity

of Trauma
Dr.Ravi Kant Singh1, Dr. Vikas Verma2, Prof.Ashish Kumar3,
Prof. Rajeshwar Nath Srivastva4, Dr.Nidhi Singh5, Prof. G.K. Singh6,
Dr.Ravi Kant Singh7
1

PhD Scholar (Deptt.of Orthopaedics)King Georges Medical UniversityUttar Pradesh. India

2
Associate Professor (Deptt.of Orthopaedics)Integral Institute of Medical Sciences and
Research (Lucknow) U.P.
3
Deptt.of Orthopaedics (KGMU) 4Deptt.of Orthopaedics (KGMU)
5
Founder President (OSSESD) 6Founder Director (AIIMS), Patna, Bihar
7
PhD Scholar (Deptt.of Orthopaedics)King Georges Medical University
Uttar Pradesh. India

I.

Introduction

Road traffic injuries (RTIs) are included under unintentional injuries. The definition of road traffic
fatality varies in different countries and is defined as any person killed immediately or dying within 30 days as
a result of an injury or accident (Mohan et al, 2006). According to WHO, RTIs are the sixth leading cause of
death in India with a greater share of hospitalizations, deaths, disabilities and socioeconomic losses in young
and middle-age populations (Ministry of Health and Family Welfare, 2004).
The Abbreviated Injury Scale (AIS) was first introduced in 1969 as an anatomic scoring system to
categorise automobile victims for epidemiological purposes (Marcin and Pollack, 2002). It underwent revision
in 1990, and body regions for the AIS were identified as follows: head, face, neck, thorax, abdomen and pelvic
content, spine, upper extremities, lower extremities, and unspecified. In this revised version, external injuries are
dispersed across body regions, and the AIS provide a reasonably accurate way of ranking the severity of injury
by body regions.
With the AIS, injuries are ranked on an ordinal scale ranging from 1 to 6, with 1 being considered a
minor injury or least severe, 5 being a severe injury or survival uncertain, and 6 being an un-survivable injury
(Stevenson et al, 2001). An AIS score 3 is considered serious. The AIS correlates well with the degree of
injury but suffers as a prognostic tool because it does not take physiologic derangements or chronic health into
account.

II.

Material And Methods

Study design: Prospective Observational Study (cross-sectional)

Study setting: Patients coming to the OPD and trauma centre of CSMMU, Lucknow were included in the study.
Study subjects: Injured patients from Lucknow and adjoining areas. This represents the target population since
ninety percent of adult injured patients admitted to CSMMU Trauma Centre are direct admissions.
Sampling Frame: Injured patients admitted to CSMMU trauma centre, ninety percent of which are direct
admissions and ten percent are referred patients. Patients who meet the inclusion criteria shall be consecutively
recruited to ensure random selection.
Inclusion/Exclusion criteria
Patients admitted in CSMMU trauma centre, suffered injuries due to road traffic accidents were
included in the study. An injury on road without involvement of vehicle (Persons slipping & falling on the road
& sustaining injury), injury involving a stationary vehicle (e.g. Persons getting injured while washing or loading
a vehicle), brought dead due to RTA, patients not giving informed consent(in coma ,unconscious, for more than
3 days post injury & unable to understand or reply due to shock), patient referred to CSMMU trauma centre
after being treated elsewhere for more than 3 days, burn patients and patients under 12 yrs of age were excluded
from the study. Accident victims were allocated into two groups, ie, those with severe injuries to the extremities
or pelvis (Abbreviated Injury Scale [AIS] 34) and those without injuries or with minor injuries to the
extremities (AIS 02).
DOI: 10.9790/0853-14732730

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Effect Of Road Conditions And Number Of Passengers

Analysis: The analysis was carried out by using SPSS 16.0 version (Chicago, Inc., USA). The univariate and
multivariate logistic regression analysis was carried out to find the strength of the association between road
conditions and severity of AIS. The p-value<0.05 was considered significant.

III.

Results

Majority (78.6%) of the accidents happened on plane road. The percentage of other road condition was
almost less than 5%. The percentage of AIS 3-4 was 84.5% and AIS 0-2 was 15.5% among the patients who got
accident on plane roads. The risk of AIS 3-4 was 14.77 times significantly higher among the patients who got
accident on plane roads compared with poor road conditions (OR=14.77, 95%CI= 7.73-28.21, p=0.0001). The
percentage of AIS 3-4 was higher in all the road conditions than AIS 0-2. It was also observed that the risk of
AIS 3-4 was significantly higher among the patients who accident on slippery road, pot holed, Kharanja, under
construction, dust and sand than poor road conditions (Table-1).
In more than one third (37.2%) accidents, the number of passengers were one and in 32.9% of the
accidents, the number of passengers were two. 3-6 passengers were in 14.5% accidents and 7-8 were in 12.3%
accidents. The AIS 3-4 was in 90.7% patients and AIS 0-2 was in 9.3% in the accidents whom the number of
passenger was one. The risk of AIS 3-4 was significantly higher in the accidents whom number of passenger
was one compared to the accidents having the number of passenger >8 (OR=3.41, 95%CI=1.33-8.74, p=0.01).
The risk of AIS 3-4 was also higher among the accidents having number of passengers 2, 3-6 and 7-8, however,
this was statistically not significant (p>0.02) (Table-2).
Most of the accidents happened on major road (59%) followed by state highway (28%). The percentage
of other place of accidents were less than 5%. The percentage of AIS 3-4 was higher than AIS 0-2 among the
patients who got accident at any location except for cross road. The risk of AIS 3-4 was higher among the
patients who got accident at national highway, state highway, major road, junctions than cross road (Table-3).
In the multivariate analysis, the risk of AIS 3-4 was significantly (p<0.05) higher for all the road
conditions than poor road condition except for slippery which was significant in the univeratite analysis. The
risk AIS 3-4 was found to be significantly higher in accidents having only one passenger than >8 passengers in
the multivariate analysis (Adjusted OR=6.24, 95%CI=2.21-17.63). The risk of AIS 3-4 was also higher among
the patients who got accident at any location than cross road except for junctions (Table-4).

IV.

Discussion

In the present study, majority of the accidents occurred on plane road. In India, such type of roads are
not good in condition. Ply-worthy roads are a prerequisite for effective RTA prevention (Verma and Tewari,
2004; Zheng, 2004; Transport and Road Research Laboratory, 2005). So, there is a need of timely road
maintenance, proper road engineering with sufficient traffic signs which can go a long way in improving the
road worthiness of the roads.
According to a study in Nepal study, 213 (59.16%) of accidents were collision type and 147 (40.83%)
were non-collision type. Narrow and defective roads were responsible for 39 (26.53% ) of non-collision
accidents where as collision types occurred mostly in wide roads i.e. 132 (61.97%) (Mishra et al, 2010).
In this investigation, in more than one third (37.2%) accidents, the number of passengers were one and
in 32.9% of the accidents, the number of passengers were two. We observed that the most of the accidents
happened on major road (59%) followed by state highway (28%). The percentage of other place of accidents
were less than 5% in this study. In our best knowledge, none of the studies have reported such type of data.
A number of scoring systems have been developed to facilitate consistent trauma triage, severity
evaluation, management and prognostication (Kobusingye et al, 2002). These include the Injury Severity Score
(ISS), Pediatric Trauma Score (PTS), Abbreviated Injury Score (AIS), Revised Trauma Score (RTS) and
Trauma score and injury severity score (TRISS) (Brenneman et al, 1998). In the present study, the severity of
injury was determined using the Kampala trauma score II (KTS II) whose validity and reliability for use in both
adults and children was described elsewhere (Mutooro et al, 2010). This scoring system, compares favorably
with other trauma scoring systems such as the Revised Trauma Score (RTS) and Injury Severity Score
(ISS) (Brenneman et al, 1998). It is scored based on age, number of serious injuries, systolic blood pressure,
respiratory rate and neurologic status on presentation.
In this study, we evaluated the severity of trauma by using AIS. The percentage of AIS 3-4 was higher
than AIS 0-2 in this study. It was also observed that there was significant association between AIS and road
conditions, number of passengers at the time victim as well as location of the victims. In the multivariate
analysis too, these factors were associated with AIS. Jos et al (2011) evaluated one-month hospital mortality
in victims with injuries of the extremities.

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Effect Of Road Conditions And Number Of Passengers

A total of 3489 accident victims were evaluated; 3244 (92.98%) did not suffer injuries or had minor
injuries of the extremities (AIS 02) and 245 (7.02%) had severe injuries (AIS 34). Of the 245 patients with
AIS 34 extremity injuries, 13 (5.31%) patients died, and of those without severe injuries to the extremities, 34
(1.05%) died (Fishers Exact test P = 0.0000, relative risk 5.063, 95% confidence interval [CI]: 2.7079.467).

References
[1]

Mohan D, Tiwari G, Khayesi M, Nafukho FM. Road traffic injury prevention: Training manual. Geneva, Delhi:World Health
Organization, Indian Institute of Technology; 2006.
Ministry of Health and Family Welfare. Integrated Disease Surveillance Project: Project Implementation Plan 200409. New
Delhi:Government of India; 2004: 118.
Marcin JP, Pollack MM.Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma.
Crit Care Med 2002; 30:S457S467.
Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new
injury severity score. Injury Prevention 2001; 7:1013.
Verma PK, Tewari KN. Epidemiology of road traffic injuries in Delhi: Result of a survey, Regional Health Forum WHO South-East
Asia Region; 2004.
Zheng Y. Road Traffic Accidents Information System Second Year Report, 2004.
Transport and Road Research Laboratory. Towards safe roads in developing countries: A guide for planners and engineers.
Crowthorne Berkshine UK: 2005.
Mishra B, Sinha ND, Sukhla S K, Sinha A K. Epidemiological study of road traffic accident cases from Western Nepal. Indian J
Community Med 2010;35:115-21
Kobusingye OC, Guwatudde D, Owor G, Lett RR: Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj
Prev 2002, 8:133-136.
Brenneman FD, Boulonger BR, McLellan BA, Redelmeier DA: Measuring injury severity: time for a change? J Trauma Inj Inf Crit
Care 1998, 44(4):580-584.
Mutooro SM, Mutakooha E, Kyamanywa P: A comparison of Kampala trauma score II with the new injury severity score in
Mbarara University Teaching Hospital in Uganda. East Cent Afr J Surg 2010, 15(1):62-70.

[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]

Table-1: Distribution of the subjects according to road condition and degree injury to the extremity
Road condition

Plane
Slippery
Pot holed
Kharanja
Under construction
Dust
Sand
Poor condition
Total

Total cases
No.
683
22
25
21
29
19
18
52
869

%
78.6
2.5
2.9
2.4
3.3
2.2
2.1
6.0
100.0

AIS 3-4
No.
577
16
23
17
26
15
15
14
703

AIS 0-2

%
84.5
72.7
92.0
81.0
89.7
78.9
83.3
26.9
80.9

No.
106
6
2
4
3
4
3
38
166

Unadjusted OR (95%CI)

%
15.5
27.3
8.0
19.0
10.3
21.1
16.7
73.1
19.1

14.77 (7.73-28.21)
7.23 (2.36-22.19)
31.21 (6.49-149.95)
11.53 (3.30-40.25)
23.52 (6.14-90.11)
10.17 (2.88-35.94)
13.57 (3.40-54.09)
1.00 (Ref)

p-value

0.0001*
0.001*
0.0001*
0.0001*
0.0001*
0.0001*
0.0001*

OR-Odds ratio, CI-Confidence interval, *Significant, Ref.-Reference

Table-2: Distribution of the subjects according to no. of passengers and degree of injury to the extremity
No. of passengers

1
2
3-6
7-8
>8

Total cases
No.
323
286
126
107
27

%
37.2
32.9
14.5
12.3
3.1

AIS 3-4
No.
293
234
96
60
20

AIS 0-2
%
90.7
81.8
76.2
56.1
74.1

No.
30
52
30
47
7

%
9.3
18.2
23.8
43.9
25.9

OR (95%CI)

p-value

3.41 (1.33-8.74)
1.57 (0.63-3.91)
1.12 (0.43-2.90)
0.44 (0.17-1.14)
1.00 (Ref.)

0.01*
0.32
0.81
0.09

OR-Odds ratio, CI-Confidence interval, *Significant, Ref.-Reference

Table-3: Distribution of the subjects according to accident location and degree of injury to the extremity
Accident location
National highway
State highway
Major road
Street
Junctions
Cross road

Total cases
No.
%
31
3.6
243
28.0
513
59.0
24
2.8
22
2.5
36
4.1

AIS 3-4
No.
29
206
425
24
13
6

%
93.5
84.8
82.8
100.0
59.1
16.7

AIS 0-2
No.
%
2
6.5
37
15.2
88
17.2
0
0.0
9
40.9
30
83.3

OR (95%CI)

p-value

72.50 (13.51-388.89)
27.83 (10.83-71.53
24.14 (9.75-59.75)
7.22 (2.13-24.48)
1.00 (Ref.)

0.0001*
0.0001*
0.0001*
0.002*

OR-Odds ratio, CI-Confidence interval, *Significant, Ref.-Reference

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Effect Of Road Conditions And Number Of Passengers

Table-4: Results of multivariate logistic regression analysis
Factors
Road condition
Plane
Slippery
Pot holed
Kharanja
Under construction
Dust
Sand
Poor condition
No. of passengers
1
2
3-6
7-8
>8
Accident location
National highway
State highway
Major road
Street
Junctions
Cross road

Adjusted OR

95%CI

p-value

Lower
2.49
0.88
2.83
1.38
2.76
1.03
1.16

Upper
15.00
12.41
90.40
23.20
56.00
18.59
24.97

0.0001*
0.07
0.002*
0.01*
0.001*
0.04*
0.03*

6.24
2.62
1.92
2.23
1.00 (Ref)

2.21
0.96
0.68
0.73

17.63
7.19
5.45
6.81

0.001*
0.06
0.21
0.15

32.14
8.61
6.02
2.238
1.00 (Ref)

4.92
2.67
1.93
0.51

210.00
27.76
18.79
9.70

0.0001*
0.0001*
0.002*
0.28

6.11
3.32
16.01
5.66
12.43
4.38
5.38
1.00 (Ref)

OR-Odds ratio, CI-Confidence interval, *Significant, Ref.-Reference

DOI: 10.9790/0853-14732730

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